Provider Update Newsletter
This is the workhorse in our communications stable of materials. We launched our first edition in October 2020. It is delivered to all providers electronically each month. This communication vehicle covers essential operational and procedural topics to help you do business with Buckeye. It will also deliver training and education opportunities and include some of Buckeye's provider-based initiatives. All editions of the newsletter will be available on the website.
Welcome to the Buckeye Provider Update Newsletter. We believe that communication is vital to a successful partnership and our goal is to establish a plan to communicate essential information to make working with Buckeye easier. For easy access and reference, we’ll store the communications in the Provider Communications page of our website.
To help streamline the number of communications and better categorize the information for your use, we will be introducing new provider communication categories over the next few months.
- Provider Update Newsletter: delivered on a monthly basis, this will be latest in operational changes, processes and procedures. We’ll also throw in some strategic initiatives and opportunities for you to partner with Buckeye.
- Provider Notices: specific notices from ODM, CMS or Buckeye operations/policies that you need to know, but can’t wait for the newsletter.
- Provider Alerts: urgent information that needs immediate reporting to our valued providers.
- Special Announcements: positive information worthy of creating a spotlight to showcase exciting company and community-based activities.
Our hope is that you find these communications both helpful and easy to use. We want to make your job easier, so we welcome your feedback and suggestions and look forward to connecting with you!
Provider Update Newsletter Sign-up Form
Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us and partner together in service to our members and communities. Please go to our Provider Communications Sign-Up Form and let us know if you have questions. Even if you have received our communications via email in the past, please sign up for future communications. We’ve gathered email addresses from various resources, but may not have your other information we need to customize specific messages in future communications.
HEDIS - Q4 Targeted Measures
COVID-19 continues to impact our members and providers. We are seeing significant declines in the number of members who are making preventative care appointments with their PCPs. We need your help to close all 2020 gaps in care. Please review your patient records and contact Buckeye members who have missed appointments – particularly those who are not compliant on HEDIS-related measures. Buckeye is here to help. Remind them we offer:
- Transportation to and from provider offices for well-care and treatment; and trips to the pharmacy for medications.
- No-cost telehealth visits for patients who may have transportation or health related barriers to making an in-person visit.
Your Buckeye provider representative is here to help you identify ways to reach members and close care gaps. If you are unsure who your representative is, please contact Provider Services at 866-296-8731.
Targeted HEDIS measures for Q4 2020. You can find the full descriptions on our website:
- Breast Cancer Screening
- Cervical Cancer Screening
- Post-Partum Care
- Adult Access
- Child Access
- Annual Dental Visit
- Comprehensive Diabetes Care: HbA1c (Poor Control, Testing), Eye Exams, Blood Pressure
- APM, SMC, SMD, SDD
- COA, COL, PCR, MDS
We value our partnership and thank you for your continued support.
New COVID-19 Telehealth Guidelines
In order to ensure that all Ohio Medicaid members have needed access to care, the Ohio Department of Medicaid (ODM) and Medicaid Managed Care Plans (MCPs) are increasing the scope and scale of reimbursement for telehealth services for Medicaid recipients during the duration of the COVID-19 emergency. These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to reduce their exposure in public settings. Through collaboration with providers and ODM, the short-term goal of the MCPs is to expand access to critical patient care through the time of emergency, with the overarching goal of creating a future state centered on sustainability and person-centered quality metrics. See the MCP Telehealth Policy and Provider Telehealth Resource Guide.
A network that provides seamless COVID-19 care for your patients.
LOB: Marketplace and Medicaid PCPs
The COVID-19 global pandemic has created unprecedented changes to our lives and healthcare systems. While we continue to connect our members to COVID-19 services, we want to reach out to our provider partners on how we can work together to better support their care needs. As a primary care physician (PCP), you are at the heart of our members’ healthcare. They trust and rely on you See More
October is Mental Health & Breast Cancer Awareness Month
Mental Health Awareness
Each year, millions of Americans face the reality of living with a mental health condition. However, mental illness affects everyone directly or indirectly through family, friends or coworkers. Despite mental illnesses’ reach and prevalence, stigma and misunderstanding are also, unfortunately, widespread (NAMI, 2020). Read: The Impact of Stigma on Substance Use Disorders
Buckeye Encourages Breast Cancer Screenings During National Awareness Month
In honor of Breast Cancer Awareness Month, Buckeye is encouraging Ohioans to get their breast cancer screenings. Because some Ohioans may fear exposure to COVID-19 by visiting their doctor, it’s important for physicians offices to reach out to patients and encourage them to get this important screening. “Getting a mammogram has never been faster or easier,” said Dr. Brad Lucas, Buckeye’s chief medical officer. “It takes 30 minutes or less and can give your patient peace of mind.”
Flu Prevention: You can help stop the flu!
Strongly recommend to all of your patients to get their annual flu shot.
You have a key role to play in recommending that your patients get the flu shot. Buckeye Health Plan is here to help. See our Fluvention Campaign page here.
Important events and educational offerings from ODM and our partners:
As you may know, efforts are underway to assist providers in becoming fully compliant with Ohio’s EVV requirements. The webinars scheduled for October and November are part of that effort.
Auto-verification of visits occurs when no provider action is necessary after the visit is recorded at the time of service. All required information is captured and no exceptions are posted. Join us at one of the following webinars to learn more about auto-verification, why exceptions post to your visits, and how to achieve auto-verification of your visits.
Webinar (Link) Date/Time
Streamlining EVV Workflow Tuesday, October 27, 2020, 3:30pm – 4:30pm EST
Streamlining EVV Workflow Tuesday, November 3, 2020, 2:30pm – 3:30pm EST
Streamlining EVV Workflow Friday, November 6, 2020, 10:00pm – 11:00pm EST
Please share this information with others who may be interested or benefit from the webinars.
Free Virtual Event:
2020 Reversing the Trend of Irreversible Actions - Store It Safe Virtual Fundraiser
November 20th: 11:30 AM-1:00 PM
Interdisciplinary panel on teen suicide prevention -- Featuring Injury Prevention Medical Directors Dr. Mike Gittelman and Dr. Sarah Denny plus Denise Meine-Graham from Franklin County Loss. Also back this year, due to overwhelming requests from former attendees, is teen advocate, Jeremy Hardjono!
This message is so important and timely that we have decided to make the event FREE for all to attend. It is essential that we all learn more about teen mental health and safe storage practices to prevent suicide. Register here. While you’re there, check out the Buckeye Health Plan Virtual Exhibit.
Ohio AAP is now offering LIVE VIRTUAL versions of in-office MOBI & TIES!
These enhanced trainings offer the same content as our traditional MOBI & TIES, while also adding in COVID-19 information, with a focus on provider and practice guidance during and post-pandemic.
Our virtual MOBI & TIES include:
- Guidance on continuing immunization best practices
- Epidemiology & background of COVID-19
- Practice operation guidance in a pandemic (i.e. telehealth)
- 1-hour CME for each session
Please contact Lory Sheeran Winland, Director of Immunization Programs, at email@example.com to request a live virtual MOBI and/or TIES.
Nationwide Children’s Hospital (NCH)
Project ECHO – Advanced Series: Eating Disorders in Primary Care (register by 10-26)
October 29: Noon to 1:00 p.m., Prevention and Identification of Eating Disorders in Primary Care
November 12: Recognize and Refer Eating Disorders in Primary Care
- Learn to differentiate between eating disorders
- Learn preventative measures for use within your practice
- Understand assessment and treatment options in primary care setting
- Compile resources and referral information to your practice and patients
Project ECHO – Advanced Series (2 parts): Gender Dysphoria in Primary Care
November 5: Noon to 1:00 p.m. Emotional and Behavioral Health of Today’s Genderation ” of Children and Adolescents: The Role of the Pediatrician and Primary Care Providers
November 19: Gender Affirming Medical Care
- Learn relevant terminology with respect to gender and sexuality constructs
- Learn ways to create a welcoming office environment for gender diverse patients and families
- Understand non-medical and medical options for treatment
- Compile resources and referral information for your practice and patients
New Opioid Program
As part of the initiative to combat the opioid epidemic, Buckeye Health Plan has adopted a Drug Management Program (DMP) for beneficiaries at-risk for misuse or abuse of frequently abused medications. Learn more about Use of Opioids from Multiple Providers.
Partnership with Mercy Health Overcomes COVID Barriers to Preventive Health Checks
Challenge: Encourage Buckeye members who have chronic health conditions to complete their annual preventative visit with their PCP. Read about our successful outcome!
Good News for our Ambetter OB/GYNs
In our goal to make working with us easier, we’re pleased to announce that Buckeye has removed the PA requirements for OB-Ultrasound. As of September 24, 2020, participating OB/GYNs will no longer need to submit an OB prior authorization for OB-Ultrasounds. Non-participating providers must continue to submit the prior authorization and receive approval before services are rendered.
Buckeye Partners With Lower Lights CHC to Pilot New Healthy Food Rx Program
Did you know that Buckeye partners with providers across Ohio to offer programs that help our members overcome obstacles to care and social determinants of health? In 2020, we partnered with Lower Lights Christian Healthcare Center, an FQHC in urban Columbus, to successfully pilot a Healthy Food Rx program for adult Medicaid members who have chronic health condition. The program provides nutrition education and healthy food each month. We are looking to expand our program in 2021. Read more details, see an inspiring video journal and let us know if you’d like to partner with us next year.
Buckeye Cares for the Whole Person
Medical care is a top priority, but at Buckeye we work to meet the many needs that may impact our member’s ability to access that care. We want to ensure services are provided that meet the needs of the whole person. Check out our programs that go the extra mile to care for our members.
BH Utilization Management - When to use ASAM
As announced by Ohio Department of Medicaid, they have a new requirement to ensure clinical consistency and coverage of Medicaid services across the full ASAM continuum. To make things easier, Buckeye has summarized the new requirement and created a form to help guide you.
Welcome to the November 2020 Provider Update Newsletter
Thank you for all you do!
In this season of giving thanks, Buckeye would like to thank our valued providers for the exceptional care you give our members. We appreciate your partnership in delivering high-quality and compassionate care for the best possible outcomes. We wish you and your families a safe and enjoyable holiday.
Our Provider Services will be closed Thursday and Friday, November 26 and 27, 2020 in observance of the Thanksgiving holiday. Please let us know if you have any questions.
Provider Update Newsletter Sign-up Form
Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. Please sign up for Provider Communications. Even if you have received our email communications in the past, please sign up for future communications.
Flu Shot Reminder: You can make a difference! Help your patients get their flu shot.
- Make a strong recommendation to your patients to get their flu shot. Research shows that patients are more likely to get a flu shot if their doctor recommends it.
- Follow-up is important! Talk to your patients about where and when they’ll get their flu shot, and make a note to confirm during their next visit.
- Talk with your patient about any questions or concerns — and be sure to repeat your strong recommendation. Most people know the flu shot is important. They may just need your reminder!
See our Fluvention page on our website for more details and Talking Points.
Ambetter 2021 Expansion
Buckeye’s Marketplace Exchange health plan, Ambetter, will be available for members in 27 additional Ohio counties for 2021. Ambetter delivers the high quality, comprehensive coverage that your patients deserve. This coverage offers valuable programs and educational tools for your patients, making it easier for them to stay in charge of their health. We look forward to partnering with you to improve the healthcare outcomes of our members.
You can see our Ambetter expansion counties on our Ambetter Plans on the website. If you have already joined the Ambetter network and would like to participate in an Instructor-Led Orientation, please see our Training page. These one-hour webinars discuss the Ambetter plan, claims, authorizations, web access, reference materials and key contacts at Buckeye Health Plan.
If you have any questions, please contact Provider Services.
Utilization Management Updates
- PA Authorization requirements changes for long term acute care facilities (LTAC), skilled nursing facilities (SNF) and inpatient rehabilitation facilities (IRF hospital). Link will take them to content below.
- Re-routing calls to better support our providers.
Delivering the best possible customer service for our providers is a top priority for Buckeye. During this unprecedented pandemic time we are experiencing a significant increase in calls regarding our authorization requests. Therefore, our UM and Provider Service (PS) departments have combined forces to best meet your needs.
UM will continue to take the calls listed below:
- Authorization date changes that cannot be faxed
- Authorization needed that was initiated by Emergency Room visit
- Questions regarding additional clinical information for a request for service
- Questions about a denial
UM Department: 1-866 246-4359 M-F, 8 a.m. to noon and 1 to 5:00 p.m. (closed noon to 1:00 p.m.)
Our Provider Services representatives are standing by to assist you with the following calls:
- To start or check an authorization*
- Authorization status checks
- Requesting a care manager
- Appeal status or questions
- Assistance with our online Prior Auth Code Check Tool*
- Provider portal questions
- Member benefits*
Provider Services: 1-866-296-8731 M-F, 8 a.m. to noon and 1 to 5:00 p.m. (closed noon to 1:00 p.m.)
* Self-Service tools on our provider portal.
Warm transfers between UM and Provider Services will be provided, as needed. We hope this change will help us to quickly address the needs of our providers.
Medicare 2021 Prior Authorization List has been posted to the Prior Authorization page of our website.
Introducing Buckeye’s Provider Accessibility Initiative
Buckeye is working to remove barriers our members may have accessing provider locations. We want to enable our members to view provider location’s disability access information so they can find a provider based on their own disability access needs. For this initiative to work, we need to hear from you.
Member Transportation Benefit Includes Access to Food
Buckeye offers member transportation, at no cost to them, that help members get to medical, dental and vision appointment. Did you know they also provide transportation for non-medical reasons, such as access to food? See more details and other non-medical reasons.
Buckeye Health Plan Raises Awareness for Breast Cancer
Breast cancer is the second most common cause of cancer-related death for Ohio women. But when it’s detected early, most breast cancer can be treated successfully. We encourage age appropriate mammograms and Buckeye can make access easier. Download a Mammogram Infographic for your patients.
Practitioners & Groups Must Enroll with ODM Prior to January 2021.
All providers who currently contract with or wish to contract with a Medicaid managed care plan (MCP) must be enrolled with the Ohio Department of Medicaid (ODM) prior to January 2021 or your claims will deny. This includes any practitioner or group practice that bills for or renders services. ODM requires professional medical groups to be enrolled as outlined in their memo.
New Patient/Client Liability Reconciliation Form
We strive to find ways to make working with Buckeye Health Plan easier. To assist in the reporting of PL errors or discrepancies for claims paid by Buckeye Health Plan we have created an easy to use Reconciliation Form and instructions for your use.
Important EVV Reminder – Phase 3 Training Required
by December 31, 2020
As of January 1, 2021, all providers who are providing Phase 3 EVV-eligible services must be using EVV. Phase 3 includes self-directed services and other services necessary to meet the requirements of the Cures Act.
The Ohio Department of Medicaid (ODM) is implementing Electronic Visit Verification (EVV) for some home and community-based services in response to federal requirements set forth in the 21st Century Cures Act (Cures Act). EVV is an electronic system that verifies key information about the services provided. In accordance with the Cures Act, the system implemented by ODM will record the date of the service, the time the service started and ended, the individual receiving the service, the person providing the service and the location of the service. Both agencies and non-agency providers are impacted by EVV.
As of January 1, 2021, all providers who are providing Phase 3 EVV-eligible services must be using EVV. A full listing of the services can be found on the Phases tab on the below link.
Also, please see sections on the link for Individual and Provider training.
Enhancements to Claims Payment Processes
You asked and we listened. We received requests from providers for Negative Balance Reports to assist in reconciling your books. Now, providers will be able to identify from which payment the Negative Balance was carried forward.
Prior to Oct. 23, 2020, the Provider Level Adjustment (PLB) did not provide sufficient information for you to auto-post remittance advices (explanations of payment in electronic format) also known as 835s.
- We have made an enhancement of the Forwarding Balance within the 835 PLB segment to include the trace number of the Negative Balance to allow you to auto-post Negative Balance 835s.
- In addition, Offsets within the 835 now contain the patient control number and the provider’s patient account number to allow you to auto-post an Offset to your balance.
These enhancements will significantly reduce issues with Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT), and increases provider self-service. You will no longer need to request Negative Balance reports in order to auto-post an ERA.
Please note: These enhancements do not apply to Negative Balances and Offsets prior to Oct. 23, 2020.